Hair-Preservation Craniotomy for Skull Base Procedures

Introduction: Cosmetic outcome is an important factor in postoperative patient satisfaction. Craniotomy with hair preservation provides cosmetic benefit, and has been shown to be equivalent to wide hair clipping in regards to surgical site infection incidence following general adult and pediatric transcranial neurosurgical procedures. Relatively fewer studies have evaluated the safety of hair preservation in transcranial skull base procedures, but the available evidence strongly suggests no additional operative risk. Despite patient-centered benefits and demonstrated equivalent risk, hair-preservation techniques have only been partially adopted by the neurosurgical community. Reported reasons for continued wide hair clipping include better access to the incision site and the persistent belief that hair preservation is associated with increased infection rates. The objectives of this study were to (1) evaluate skull base procedures performed via hair-preservation craniotomy for surgical site infections, (2) add to the existing body of evidence, and (3) increase awareness of hair preservation as a potential option for skull base surgical procedures.

Methods: Retrospective review of 25 consecutive hair-preservation transcranial surgeries performed for meningiomas and other benign and malignant skull base tumors or vascular conditions performed by a single neurosurgeon with other specialty surgeons between July 2010 and August 2012. Demographic information (age at time of surgery, gender) and operative location were recorded. The incidence of surgical site infection was determined by review of the medical record.

Results: Hair preservation was performed via 1-2-mm hair clipping (17 cases) and without hair clipping (8 cases). Case distributions for age (five <40 years, seven 40-50 years, nine 50-60 years, four >60 years old), gender (21 women, 4 men), and operative location (13 anterior fossa/craniofacial, 8 middle fossa, 4 posterior fossa) were noted. Pathologies treated included 2 malignant tumors, 17 benign tumors, 1 aneurysm, 1 skull base defect with pneumocephalus, and 4 superior semicircular canal dehiscences. Follow-up ranged from 0.7 to 18.6 months, with a mean and median of 4.1 and 2.3 months, respectively. No incidence of surgical site infections was recorded.

Conclusion: These results support previous studies suggesting that hair preservation can be performed for transcranial skull base procedures with low risk of surgical site infection. The hair-preservation strategy offers potential for improved patient satisfaction.